August 14, 2019
Provider Types 77, IC and 05 - new provider billing requirements

Applicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care and Division of Developmental Disabilities 

Based on upcoming required changes from AHCCCS that will go into effect on 1/1/2020, Mercy Care is requesting provider’s currently registered as the following provider types review the below provider reporting requirements and provide feedback on the ability of their EMR to perform this function: 
  • 77 – BH Outpatient Clinic
  • IC – Integrated Clinic
  • 05 - Clinic

Like the current provider type 29 – RHC and C2 – FQHC requirements. AHCCCS will be expanding the rendering provider requirements to provider types 77 , IC , and 05 . In order to retain information related to the actual professional practitioner (provider) participating in/performing services associated with the visit, that professional practitioner (provider) participating in/performing services must also be reported on all claims in the following manner: 
  • CMS Form 1500 (Paper/Web Claim):  Field 19
  • 837 Professional (Electronic Claim): 2300 NTE
Current FQHC requirements can be found here:

A formal notification will be released by AHCCCS in the near future and we will keep you informed at the implementation date gets closer. 

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.
Thanks for all you do!